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Exercise & Sport Nutrition Lab, Baylor University, Waco, TX1; IMAGINutrition, Laguna Nigel,
CA2; Juvalution, Fort Lauderdale, FL3; Department of Biological Sciences, Clinical Exercise
Physiology Program, Benedictine University, Lisle, IL 4; The Cooper Institute, Dallas, TX5; Human
Performance Specialists, Inc., Chandler, AZ6; Miami Research Associates, Miami, FL7;
Department of Medical History and Ethics, University of Washington, Seattle, WA8; Human
Nutrition Laboratory, Department of Nutrition and Dietetics, Kent State University, Kent, OH9;
Ohio Research Group of Exercise Science & Sports Nutrition, Wadsworth, OH10; Department of
Exercise Science and Health Promotion, Florida Atlantic University, Davie, FL11. Sports Nutrition
Review Journal. 1(1):1-44, 2004. Address correspondence to Richard_Kreider@baylor.edu.
Sport nutrition is a constantly evolving field with literally thousands of research papers published
annually. For this reason, keeping up to date with the literature is often difficult. This paper
presents a well-referenced overview of the current state of the science related to how to optimize
training through nutrition. More specifically, this article discusses: 1.) how to evaluate the
scientific merit of nutritional supplements; 2.) general nutritional strategies to optimize performance
and enhance recovery; and, 3.) our current understanding of the available science behind weight
gain, weight loss, and performance enhancement supplements. Our hope is that ISSN members find
this review useful in their daily practice and consultation with their clients. Sports Nutrition
Review Journal. 1(1):1-44, 2004.
Key Words: sport nutrition, dietary supplements, ergogenic aids, weight gain, weight loss
________________________________________________________________________________
Sports Nutrition Review Journal. A National Library of Congress Indexed Journal. ISSN # 1550-2783
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 2
interpretations of the literature and/or nutritional practices that help prepare people
categorization of a particular supplement and to perform and/or enhance recovery from
some classifications may change over time as exercise should also be viewed as ergogenic.
more research is forthcoming, these
interpretations are based on the current WHAT ARE DIETARY SUPPLEMENTS
available scientific evidence and have been AND HOW ARE THEY REGULATED?
well received within the broader scientific
community. Our hope is that ISSN members According to the Food and Drug
find this information useful in their daily Administration (FDA), dietary supplements
practice and consultation with their clients. were regulated in the same manner as food
prior to 1994 3. Consequently, the
WHAT IS AN ERGOGENIC AID? manufacturing processes, quality, and
labeling of supplements were monitored by
An ergogenic aid is any training technique, FDA. However, many people felt that the
mechanical device, nutritional practice, FDA was too restrictive in regulating dietary
pharmacological method, or psychological supplements. As a result, Congress passed
technique that can improve exercise the Dietary Supplement Health and Education
performance capacity and/or enhance training Act (DSHEA) in 1994 which placed dietary
adaptations 1, 2. This includes aids that may supplements in a special category of "foods".
help prepare an individual to exercise, In October 1994, DSHEA was signed into law
improve the efficiency of exercise, and/or by President Clinton. The law defined a
enhance recovery from exercise. Ergogenic "dietary supplement" as a product taken by
aids may also allow an individual to tolerate mouth that contains a "dietary ingredient"
heavy training to a greater degree by helping intended to supplement the diet. Dietary
them recover faster or help them stay healthy ingredients" may include vitamins, minerals,
during intense training. Although this herbs or other botanicals, amino acids, and
definition seems rather straightforward, there substances (e.g., enzymes, organ tissues,
is considerable debate regarding the ergogenic glandulars, and metabolites). Dietary
value of various nutritional supplements. supplements may also be extracts or
Some sport nutrition specialists only consider concentrates from plants or foods. Dietary
a supplement ergogenic if studies show that supplements are typically sold in the form of
the supplement significantly enhances tablets, capsules, soft gels, liquids, powders,
exercise performance (e.g., helps you run and bars. Products sold as dietary
faster, lift more weight, and/or perform more supplements must be clearly labeled as a
work during a given exercise task). On the dietary supplement.
other hand, some feel that if a supplement
helps prepare an athlete to perform or According to DSHEA, dietary supplements
enhances recovery from exercise, it has the are not drugs. Dietary supplement ingredients
potential to improve training adaptations and that were sold prior to 1994 are therefore not
therefore should be considered ergogenic. In required to be shown to be safe and/or
our view, one should take a broader view effective in clinical trials prior to being
about the ergogenic value of supplements. approved for sale by the FDA. However, new
While we are interested in determining the dietary supplement ingredients introduced
performance enhancement effects of a after 1994 must undergo pre-market review
supplement on a single bout of exercise, we for safety data by the FDA before it can be
also realize that one of the goals of training is legally sold. Supplement companies are
to help people tolerate training to a greater responsible for determining that the dietary
degree. People who tolerate training better supplements it manufactures or distributes are
usually experience greater gains from training safe and that any representations or claims
over time. Consequently, employing made about them are substantiated by
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 3
adequate evidence to show that they are not trends and signals that may suggest a
false or misleading. Because of this, DSHEA problem. Once a dietary supplement product
requires supplement manufacturers to include is marketed, the FDA has the responsibility
on the label that This statement has not been for showing that a dietary supplement is
evaluated by the FDA. This product is not unsafe before it can take action to restrict the
intended to diagnose, treat, cure, or prevent product's use or removal from the
any disease". According to the 1994 marketplace. The Federal Trade Commission
Nutrition Labeling and Education Act (FTC) is responsible to make sure
(NELA), the FDA has the ability to review manufacturers are truthful regarding claims
and approve health claims for dietary they make about dietary supplements. The
supplements and foods. However, since the FDA has the power to remove supplements
law was passed, it has only reviewed a few from the market if it has sufficient scientific
claims. The delay in reviewing health claims evidence to show the supplement is unsafe.
of dietary supplements resulted in a law suit Additionally, the FTC has the power to act
filed by Pearson & Shaw et al v. Shalala et al against companies who make false and/or
in 1993. After years of litigation, U.S. Court misleading marketing claims about a specific
of Appeals for the District of Columbia product. This includes acting against
Circuit ruled in 1999 that qualified health companies if the ingredients found in the
claims may now be made about dietary supplement do not match label claims. While
supplements with approval by FDA as long as this does not ensure the safety of dietary
the statements are truthful and based on supplements, it does provide a means for
science. Supplement companies wishing to governmental oversight of the dietary
make health claims about supplements can supplement industry if adequate resources are
submit research evidence to the FDA for provided to enforce DSHEA. Since inception
approval. Additionally, they must submit an of DSHEA, the FDA has required a number
Investigation of New Drug (IND) application of supplement companies to submit evidence
to FDA if a research study on a nutrient is showing safety of their products and acted to
designed to treat an illness and/or medical remove a number of products sold as dietary
affliction and/or the company hopes to one supplements from sale in the U.S. due to
day obtain approval for making a qualified safety concerns. Additionally, the FTC has
health claim if the outcome of the study acted against a number of supplement
supports the claim. Studies investigating companies for misleading advertisements
structure and function claims, however, do and/or structure and function claims.
not need to be submitted to the FDA as an
IND. As can be seen, although some argue that the
dietary supplement industry is unregulated
Manufacturers and distributors of dietary and/or may have suggestions for additional
supplements are not currently required to regulation, manufacturers of dietary
record, investigate or forward to FDA any supplements must adhere to a number of
reports they receive on injuries or illnesses federal regulations before a product can go to
that may be related to the use of their market. Further, they must have evidence that
products. However, the FDA and other groups the ingredients sold in their supplements are
have established phone hotlines and online generally safe if requested to do so by the
adverse event monitoring systems to report FDA. For this reason, over the last 10-15
problems they believe may be a result of years, most quality supplement companies
taking dietary supplements. While these have employed a team of researchers (many
reports are unsubstantiated, can be influenced of whom are MS or PhD prepared exercise
by media attention to a particular supplement, physiologists or sport nutrition specialists)
and do not necessarily show a cause and who help educate the public about nutrition
effect, they are used by the FDA to monitor and exercise, provide input on product
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 4
development, conduct preliminary research on and determining whether there is any well-
products, and/or assist in coordinating controlled data showing the
research trials conducted by independent supplement/technique works. Training
research teams (e.g., university based devices and supplements based on sound
researchers or clinical research sites). They scientific rationale with supportive research
also consult with marketing teams with the showing effectiveness may be worth trying
responsibility to ensure structure and function and/or recommending. However, those based
claims do not misrepresent results of research on unsound scientific rationales and/or little
findings. This has increased job opportunities to no data supporting the ergogenic value for
for sport nutrition specialists as well as people involved in intense training may not.
enhanced opportunities for external funding The sport nutrition specialist should be a
for research groups interested in exercise resource to help their clients interpret the
nutrition research. While it is true that some scientific and medical research that may
companies use borrowed science, suppress impact on their welfare and/or help them train
negative findings, and/or exaggerate results more wisely. The following are the questions
from research studies, the trend in the we recommend asking when evaluating the
nutrition industry is to develop scientifically potential ergogenic value of a supplement.
sound supplements. This trend toward greater
research support is the result of: 1.) attempts
Does The Theory Make Sense?
to honestly and accurately inform the public
about results; 2.) efforts to have data to Most supplements that have been marketed to
support safety and efficacy on products for
improve health and/or exercise performance
FDA and the FTC; and/or, 3.) to provide are based on theoretical applications derived
scientific evidence to support advertising from basic and/or clinical research studies.
claims and increase sales. This trend is due Based on these preliminary studies, a training
in large part to greater scrutiny from the FDA device or supplement is often marketed to
and FTC as a result of increased consumer
people proclaiming the benefits observed in
expectations and political pressure to ensure these basic research studies. Although the
that companies sell quality products that have theory may sound good, critical analysis of
been shown to be safe and effective in clinical the theory often reveals flaws in scientific
trials. In our experience, companies who logic and/or that the claims made dont quite
adhere to these ethical standards prosper match up with the literature cited. If you do
while those who do not struggle to adhere to your homework, you can discern whether a
FDA and FTC guidelines and lose consumer supplement has been based on sound
confidence. When this occurs, companies are scientific evidence or not. To do so, we
often sued by consumers and/or are forced out suggest you read reviews about the training
of business because ultimately the consumer method, nutrient, and/or supplement from
has the final word on whether a supplement or researchers who have been intimately
supplement company is credible or not. involved in this line of research and/or consult
reliable references about nutritional and
HOW TO EVALUATE NUTRITIONAL herbal supplements 4-8. We also suggest
ERGOGENIC AIDS doing a search on the nutrient/supplement on
the National Library of Medicines Pub Med
When you evaluate the ergogenic value of a Online 9. A quick look at these references
nutritional supplement or training will often help you know whether the theory
device/method, we recommend that you go is plausible or not. In our experience,
through a process of evaluating the validity proponents of ergogenic aids often overstate
and scientific merit of claims made. This can claims made about training devices and/or
be accomplished by evaluating the theoretical nutritional supplements while opponents of
rationale behind the supplement/technique nutritional supplements and ergogenic aids
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 5
are either unaware and/or ignorant of research Do the studies report statistically
supporting their use. The sport nutrition significant results or are claims being
specialist has the responsibility to know the made on non-significant means or trends
literature and/or search available data bases to reported? Appropriate statistical analysis
know whether there is merit or not to a of research results allows for an unbiased
proposed ergogenic aid. interpretation of data. Although studies
reporting statistical trends may be of
Is There Any Scientific Evidence Supporting interest and lead researchers to conduct
The Ergogenic Value? additional research, studies reporting
statistically significant results are
The next question suggest asking is whether obviously more convincing. With this
there is any well-controlled data showing the said, sport nutrition specialist must be
proposed ergogenic aid works as claimed in careful not to commit type II statistical
athletes or people involved in training. The error (i.e., indicating that no differences
first place we look is the list of references were observed when a true effect was seen
cited in marketing material supporting their but not detected statistically). Since many
claims. We look to see if the abstracts or studies on ergogenic aids (particularly in
articles cited are general references or specific high level athletes) evaluate small
studies that have evaluated the efficacy of the numbers of subjects, results may not reach
nutrient/supplement. We then critically statistical significance even though large
evaluate the abstracts and articles by asking a mean changes were observed. In these
series of questions. cases, additional research is warranted to
further examine the potential ergogenic
Are the studies simply basic research done aid before conclusions can be made.
in animals/clinical populations or have the Do the results of the studies cited match
studies been conducted on athletes? the claims made about the supplement?
Studies reporting improved performance It is not unusual for marketing claims to
in rats may be insightful but research greatly exaggerate the results found in the
conducted on athletes is much more actual studies. Therefore, you should
convincing. compare results observed in the studies to
Were the studies well controlled? For marketing claims. Reputable companies
ergogenic aid research, the study should accurately report results of studies so that
be a placebo controlled, double blind, and consumers can make informed decisions
randomized clinical trail if possible. This about whether to try a product or not.
means that neither the researchers nor the Were results of the study presented at a
subjects were aware which group reputable scientific meeting and/or
received the supplement or the placebo published in a peer-reviewed scientific
during the study and that the subjects were journal? At times, claims are based on
randomly assigned into the placebo or research that has either never been
supplement group. At times, supplement published or only published in an obscure
claims have been based on poorly journal. The best research is typically
designed studies (i.e., small groups of presented at respected scientific meetings
subjects, no control group, use of and/or published in reputable peer-
unreliable tests, etc) and/or testimonials reviewed journals.
which may make interpretation much Have the research findings been replicated
more difficult. Studies that are well at several different labs? The best way to
controlled clinical trials provide stronger know an ergogenic aid works is to see that
evidence as to the potential ergogenic results have been replicated in several
value than those that are not well studies preferably by a number of
controlled. researchers. The most reliable ergogenic
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 6
aids are those in which a number of and/or managing caloric intake, weight gain
studies, conducted at different labs, have supplements, weight loss supplements, and
reported similar results. performance enhancement supplements.
Based on the above criteria, we generally
Is The Supplement Legal And Safe? categorize nutritional supplements into the
following categories:
The final question we ask is whether the
supplement is legal and/or safe. Some I. Apparently Effective. Supplements that
athletic associations have banned the use of help people meet general caloric needs
various nutritional supplements (e.g., and/or the majority of research studies
prohormones, ephedra, etc). Obviously, if the show is effective and safe.
supplement is banned, the sport nutrition II. Possibly Effective. Supplements that
specialist should discourage its use. In initial studies support the theoretical
addition, many supplements have not been rationale but that more research is needed
studied for long-term safety. People who to determine how the supplement may
consider taking nutritional supplements affect training and/or performance.
should be well aware of the potential side III. Too Early To Tell. Supplements that the
effects so that they can make an informed theory may make sense but there is
decision regarding whether to use a insufficient research to support the use at
supplement or not. Additionally, they should this time.
consult with a knowledgeable physician to see IV. Apparently Ineffective. Supplements
if there are any underlying medical problems that the theoretical rationale makes little
that may contraindicate use. When evaluating scientific sense and/or research has clearly
the safety of a supplement, we suggest shown to be ineffective.
looking to see if any side effects have been
reported in the scientific or medical literature. When a sport nutrition specialist councils
In particular, we suggest determining how people who train, they should first evaluate
long a particular supplement has been studied, their diet and training program. They should
the dosages evaluated, and whether any side make sure that the athlete is eating an energy
effects were observed. We also recommend balanced, nutrient dense diet and that they are
consulting the PDR for nutritional training intelligently. This is the foundation
supplements and herbal supplements to see if to build a good program. Following this, we
any side effects have been reported and/or recommend that they generally only
there are any known drug interactions. If no recommend supplements in category I. If
side effects have been reported in the someone is interested in trying supplements in
scientific/medical literature, we generally will category II, they should make sure that they
view the supplement as safe for the length of understand that these supplements are more
time and dosages evaluated. experimental and that they may or may not
see the type of results claimed. We
recommend discouraging people from trying
CLASSIFYING AND CATEGORIZING
supplements in category III because there
SUPPLEMENTS
isnt enough data available on whether they
work or not. However, if someone wants to
Dietary supplements may contain
try one of these supplements, they should
carbohydrate, protein, fat, minerals, vitamins,
understand that although there is some
herbs, and/or various plant/food extracts.
theoretical rationale, there is little evidence to
Supplements can generally be classified as
support use at this time. Obviously, we do
convenience supplements (e.g., energy bars,
not support athletes taking supplements in
meal replacement powders, ready to drink
categories IV. We believe that this approach
supplements) designed to provide a
is a more scientifically supportable and
convenient means of meeting caloric needs
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 7
balanced view than simply dismissing the use needs may approach 50 80 kcals/kg/day
of all dietary supplements out of hand. (2,500 8,000 kcals/day for a 50 100 kg
athlete). For elite athletes, energy
expenditure during heavy training or
GENERAL DIETARY GUIDELINES competition may be enormous. For example,
FOR ACTIVE INDIVIDUALS energy expenditure for cyclists to compete in
the Tour de France has been estimated as high
A well-designed diet that meets energy intake as 12,000 kcals/day (150 - 200 kcals/kg/d for
needs and incorporates proper timing of a 60 80 kg athlete) 13-15. Additionally,
nutrients is the foundation upon which a good caloric needs for large athletes (i.e., 100 150
training program can be developed. Research kg) may range between 6,000 12,000
has clearly shown that athletes that do not kcals/day depending on the volume and
ingest enough calories and/or do not consume intensity of different training phases 13.
enough of the right type of macronutrients
may impede training adaptations while Although some argue that athletes can meet
athletes who consume a good diet can help caloric needs simply by consuming a well-
the body adapt to training. Moreover, balanced diet, it is often very difficult for
maintaining an energy deficient diet during larger athletes and/or athletes engaged in high
training may lead to loss of muscle mass, volume/intense training to be able to eat
increased susceptibility to illness, and enough food in order to meet caloric needs 1,
increase prevalence of overreaching and/or 11, 13-15
. Maintaining an energy deficient diet
overtraining. Incorporating good dietary during training often leads to significant
practices as part of a training program is one weight loss (including muscle mass), illness,
way to help optimize training adaptations and onset of physical and psychological
prevent overtraining. The following symptoms of overtraining, and reductions in
overviews energy intake and major nutrient performance 12. Nutritional analyses of
needs of active individuals. athletes diets have revealed that many are
susceptible to maintaining negative energy
Energy Intake intakes during training. Susceptible
populations include runners, cyclists,
The first component to optimize training and swimmers, triathletes, gymnasts, skaters,
performance through nutrition is to ensure the dancers, wrestlers, boxers, and athletes
athlete is consuming enough calories to offset attempting to lose weight too quickly 11.
energy expenditure 1, 10-12. People who Additionally, female athletes have been
participate in a general fitness program (e.g., reported to have a high incidence of eating
exercising 30 - 40 minutes per day, 3 times disorders 11. Consequently, it is important for
per week) can generally meet nutritional the sport nutrition specialist working with
needs following a normal diet (e.g., 1,800 athletes to ensure that athletes are well-fed
2,400 kcals/day or about 25 - 35 kcals/kg/day and consume enough calories to offset the
for a 50 80 kg individual) because their increased energy demands of training and
caloric demands from exercise are not too maintain body weight. Although this sounds
great (e.g., 200 400 kcals/session) 1. relatively simple, intense training often
However, athletes involved in moderate levels suppresses appetite and/or alters hunger
of intense training (e.g., 2-3 hours per day of patterns so that many athletes do not feel like
intense exercise performed 5-6 times per eating 11. Some athletes do not like to
week) or high volume intense training (e.g., exercise within several hours after eating
3-6 hours per day of intense training in 1-2 because of sensations of fullness and/or a
workouts for 5-6 days per week) may expend predisposition to cause gastrointestinal
600 1,200 kcals or more per hour during distress. Further, travel and training
exercise 1, 13. For this reason, their caloric schedules may limit food availability and/or
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 8
the types of food athletes are accustomed to consuming 0.5 2.0 kg of spaghetti.
eating. This means that care should be taken Preferably, the majority of dietary
to plan meal times in concert with training as carbohydrate should come from complex
well as make sure athletes have sufficient carbohydrates with a low to moderate
availability of nutrient dense foods glycemic index (e.g., grains, starches, fruit,
throughout the day for snacking between maltodextrins, etc). However, since it is
meals (e.g., drinks, fruit, carbohydrate/protein physically difficult to consume that much
bars, etc) 1, 10, 11. For this reason, sport carbohydrate per day when an athlete is
nutritionists often recommend that athletes involved in intense training, many
consume 4-6 meals per day and snack in nutritionists and sport nutrition specialist
between meals in order to meet energy needs. recommend that athletes consume
Use of nutrient dense energy bars and high concentrated carbohydrate juices/drinks
calorie carbohydrate/protein supplements and/or consume high carbohydrate
provides a convenient way for athletes to supplements to meet carbohydrate needs.
supplement their diet in order to maintain While consuming this amount of carbohydrate
energy intake during training. is not necessary for the fitness minded
individual who only trains 3-4 times per week
Carbohydrate for 30-60 minutes, it is essential for
competitive athletes engaged in intense
The second component to optimizing training moderate to high volume training.
and performance through nutrition is to
ensure that athletes consume the proper Protein
amounts of carbohydrate, protein and fat in
their diet. Individuals engaged in a general There has been considerable debate
fitness program can typically meet regarding protein needs of athletes 16-20.
macronutrient needs by consuming a normal Initially, it was recommended that athletes
diet (i.e., 45-55% carbohydrate [3-5 do not need to ingest more than the RDA
grams/kg/day], 10-15% protein [0.8 1.0 for protein (i.e., 0.8 to 1.0 g/kg/d for
gram/kg/day], and 25-35% fat [0.5 1.5 children, adolescents and adults). However,
grams/kg/day]). However, athletes involved research over the last decade has indicated
in moderate and high volume training need that athletes engaged in intense training
greater amounts of carbohydrate and protein need to ingest about 1.5 2 times the RDA
in their diet to meet macronutrient needs. For of protein in their diet (1.5 to 2.0 g/kg/d) in
example, in terms of carbohydrate needs, order to maintain protein balance 16-20. If an
athletes involved in moderate amounts of insufficient amount of protein is obtained
intense training (e.g., 2-3 hours per day of from the diet, an athlete will maintain a
intense exercise performed 5-6 times per negative nitrogen balance which can
week) typically need to consume a diet increase protein catabolism and slow
consisting of 55-65% carbohydrate (i.e., 5-8 recovery. Over time, this may lead to lean
grams/kg/day or 250 1,200 grams/day for muscle wasting and training intolerance 1, 12.
50 150 kg athletes) in order to maintain
liver and muscle glycogen stores 1, 10. For people involved in a general fitness
Research has also shown that athletes program, protein needs can generally be met
involved in high volume intense training (e.g., by ingesting 0.8 1.0 grams/kg/day of
3-6 hours per day of intense training in 1-2 protein. It is generally recommended that
workouts for 5-6 days per week) may need to athletes involved in moderate amounts of
consume 8-10 grams/day of carbohydrate intense training consume 1 1.5
(i.e., 400 1,500 grams/day for 50 150 kg grams/kg/day of protein (50 225
athletes) in order to maintain muscle glycogen grams/day for a 50 150 kg athlete) while
levels 1, 10. This would be equivalent to athletes involved in high volume intense
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 9
food choices and how to how to count fat has been shown to supersaturate
grams 1, 11. carbohydrate stores prior to competition and
improve endurance exercise capacity 1, 10, 37.
Strategic Eating and Refueling Thus, the type of meal and timing of eating
are important factors in maintaining
In addition to the general nutritional carbohydrate availability during training
guidelines described above, research has also and potentially decreasing the incidence of
demonstrated that timing and composition of overtraining.
meals consumed may play a role in
optimizing performance, training adaptations, Vitamins
and preventing overtraining 1, 10, 36, 37. In this
regard, it takes about 4 hours for carbohydrate Vitamins are essential organic compounds
to be digested and begin to be stored as which serve to regulate metabolic processes,
muscle and liver glycogen. Consequently, energy synthesis, neurological processes, and
pre-exercise meals should be consumed about prevent destruction of cells. There are two
4 to 6 h before exercise 10. This means that if primary classifications of vitamins: fat and
an athlete trains in the afternoon, breakfast is water soluble. The fat soluble vitamins
the most important meal to top off muscle and include vitamins A, D, E, & K. The body
liver glycogen levels. Research has also stores fat soluble vitamins and therefore
indicated that ingesting a light carbohydrate excessive intake may result in toxicity. Water
and protein snack 30 to 60 min prior to soluble vitamins are B vitamins and vitamin
exercise (e.g., 50 g of carbohydrate and 5 to C. Since these vitamins are water soluble,
10 g of protein) serves to increase excessive intake of these vitamins are
carbohydrate availability toward the end of an eliminated in urine. Table 1 describes RDA,
intense exercise bout 38, 39. This also serves to proposed ergogenic benefit, and summary of
increase availability of amino acids and research findings for fat and water soluble
decrease exercise-induced catabolism of vitamins. Although research has
protein 36, 38, 39. demonstrated that specific vitamins may
posses some health benefit (e.g., vitamin E,
When exercise lasts more than one hour, niacin, folic acid, vitamin C, etc), few have
athletes should ingest glucose/electrolyte been reported to directly provide ergogenic
solution (GES) drinks in order to maintain value for athletes. However, some vitamins
blood glucose levels, help prevent may help athletes tolerate training to a better
dehydration, and reduce the degree by reducing oxidative damage
immunosuppressive effects of intense (vitamin E, C) and/or help to maintain a
exercise 10, 40-45. Following intense healthy immune system during heavy training
exercise, athletes should consume (vitamin C). Theoretically, this may help
carbohydrate and protein (e.g., 1 g/kg of athletes tolerate heavy training leading to
carbohydrate and 0.5 g/kg of protein) within improved performance. The remaining
30 min after exercise as well as consume a vitamins reviewed appear to have little
high carbohydrate meal within two hours ergogenic value for athletes who consume a
following exercise 1, 36, 37. This nutritional normal, nutrient dense diet. Since dietary
strategy has been found to accelerate analyses of athletes have found deficiencies in
glycogen resynthesis as well as promote a caloric and vitamin intake, many sport
more anabolic hormonal profile that may nutritionists recommend that athletes
hasten recovery 46-48. Finally, for 2 to 3 consume a low-dose one a day multivitamin
days prior to competition, athletes should and/or a vitamin enriched post-workout
taper training by 30 to 50% and consume carbohydrate/protein supplement during
200 to 300 g/d of extra carbohydrate in their periods of heavy training. The American
diet. This carbohydrate loading technique Medical Association also recently evaluated
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 11
the available medical literature and availability of salt (sodium chloride) during
recommended that Americans consume a one- the initial days of exercise training in the heat
a-day low-dose multivitamin in order to has been reported to help maintain fluid
promote general health. Suggestions that balance and prevent dehydration. Finally,
there is no benefit of vitamin supplementation zinc supplementation during training has been
for athletes and/or it is unethical for an sport reported to decrease exercise-induced changes
nutrition specialist to recommend that their in immune function. Consequently,
clients take a one-a-day multi-vitamin and/or somewhat in contrast to vitamins, there
suggest taking other vitamins that may reduce appear to be several minerals that may
cholesterol levels (niacin), serve as enhance exercise capacity and/or training
antioxidants (Vitamin E), decrease risk to adaptations for athletes under certain
heart disease (niacin, Vitamin E), or may help conditions. However, although ergogenic
maintain a health immune system (Vitamin C) value has been purported for remaining
is not consistent with current available minerals, there is little evidence that boron,
literature. chromium, magnesium, or vanadium affect
exercise capacity or training adaptations in
Minerals healthy individuals eating a normal diet.
Suggestions that there is no benefit of mineral
Minerals are essential inorganic elements supplementation for athletes and/or it is
necessary for a host of metabolic processes. unethical for an sport nutrition specialist to
Minerals serve as structure for tissue, recommend that their clients take minerals
important components of enzymes and that research has shown may affect health
hormones, and regulators of metabolic and and/or performance is not consistent with
neural control. Some minerals have been current available literature.
found to be deficient in athletes or become
deficient in response to training and/or Water
prolonged exercise. When mineral status is
inadequate, exercise capacity may be reduced. The most important nutritional ergogenic aid
Dietary supplementation of minerals in for athletes is water. Exercise performance
deficient athletes has generally been found to can be significantly impaired when 2% or
improve exercise capacity. Additionally, more of body weight is lost through sweat.
supplementation of specific minerals in non- For example, when a 70-kg athlete loses more
deficient athletes has also been reported to than 1.4 kg of body weight during exercise
affect exercise capacity. Table 2 describes (2%), performance capacity is often
minerals that have been purported to affect significantly decreased. Further, weight loss
exercise capacity in athletes. Of the minerals of more than 4% of body weight during
reviewed, several appear to possess health exercise may lead to heat illness, heat
and/or ergogenic value for athletes under exhaustion, heat stroke, and possibly death 45.
certain conditions. For example, calcium For this reason, it is critical that athletes
supplementation in athletes susceptible to consume a sufficient amount of water and/or
premature osteoporosis may help maintain GES sports drinks during exercise in order to
bone mass. There is also recent evidence that maintain hydration status. The normal sweat
dietary calcium may help manage body rate of athletes ranges from 0.5 to 2.0 L/h
composition. Iron supplementation in athletes depending on temperature, humidity, exercise
prone to iron deficiencies and/or anemia has intensity, and their sweat response to
been reported to improve exercise capacity. exercise45. This means that in order to
Sodium phosphate loading has been reported maintain fluid balance and prevent
to increase maximal oxygen uptake, anaerobic dehydration, athletes need to ingest 0.5 to 2
threshold, and improve endurance exercise L/h of fluid in order to offset weight loss.
capacity by 8 to 10%. Increasing dietary This requires frequent ingestion of 6-8 oz of
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 12
cold water or a GES sports drink every 5 to specialists must be aware of the current data
15-min during exercise 45, 49-52. Athletes and regarding nutrition, exercise, and performance
should not depend on thirst to prompt them to and be honest about educating their clients
drink because people do not typically get about results of various studies (whether pro
thirsty until they have lost a significant or con). With the proliferation of information
amount of fluid through sweat. Additionally, available about nutritional supplements to the
athletes should weigh themselves prior to and consumer, the sport nutrition specialist,
following exercise training to ensure that they nutritionist, and nutrition industry lose
maintain proper hydration 45, 49-52. The athlete credibility when they do not accurately
should consume 3 cups of water for every describe results of various studies to the
pound lost during exercise in order adequately public. The following overviews several
rehydrate themselves 45. Athletes should train classifications of nutritional supplements that
themselves to tolerate drinking greater are often taken by athletes and categorizes
amounts of water during training and make them into apparently effective, possibly
sure that they consume more fluid in effective, too early to tell, and apparently
hotter/humid environments. Preventing ineffective supplements based on my
dehydration during exercise is one of the most interpretation of the literature. It should be
effective ways to maintain exercise capacity. noted that this analysis will primarily focus
Finally, inappropriate and excessive weight on whether the proposed nutrient has been
loss techniques (e.g., cutting weight in saunas, found to affect exercise and/or training
wearing rubber suits, severe dieting, vomiting, adaptations based on the current available
using diuretics, etc) are extremely dangerous literature. Additional research may reveal it
and should be prohibited. Sport nutrition may or may not possess ergogenic value
specialists can play an important role in which may then change its classification. It
educating athletes and coaches about proper should be also noted that although there may
hydration methods and supervising fluid be little ergogenic value to some nutrients,
intake during training and competition. there may be some potential health benefits
that may be helpful for some populations.
DIETARY SUPPLEMENTS AND Therefore, just because a nutrient does not
ATHLETES appear to affect performance and/or training
adaptations, that does not mean it may not
Most of the work we do with athletes have possible health benefits.
regarding sport nutrition is to teach them and
their coaches how to structure their diet and Convenience Supplements
time food intake to optimize performance and
recovery. Dietary supplements can play a Convenience supplements are meal
meaningful role in helping athletes consume replacement powders (MRPs), ready to drink
the proper amount of calories, carbohydrate, supplements (RTDs), energy bars, and
and protein in their diet. However, they energy gels. They currently represent the
should be viewed as supplements to the diet, largest segment of nutrition industry
not replacements for a good diet. While it is representing 50 75% of most companys
true that most dietary supplements available sales. They are typically fortified with 33
for athletes have little scientific data 50% of the RDA for vitamins and minerals
supporting their potential role to enhance and typically differ on the amount of
training and/or performance, it is also true carbohydrate, protein, and fat they contain.
that a number of nutrients and/or dietary They may also differ based whether they are
supplements have been shown to help fortified with various nutrients purported to
improve performance and/or recovery. This promote weight gain, enhance weight loss,
can help augment the normal diet to help and/or improve performance. Most people
optimize performance. Sport nutrition view these supplements as a high quality
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 13
snacks and/or use them to help control caloric Therefore, we typically do not recommend
intake when trying to gain and/or lose weight. this type of weight gain approach.
In our view, MRPs, RTDs, and energy
bars/gels can provide a convenient way for Creatine. In our view, the most effective
people to meet specific dietary needs and/or nutritional supplement available to athletes to
serve as good alternatives to fast food. Use of increase high intensity exercise capacity and
these types of products can be particularly muscle mass during training is creatine.
helpful in providing carbohydrate, protein, Numerous studies have indicated that creatine
and other nutrients prior to and/or following supplementation increases body mass and/or
exercise in an attempt to optimize nutrient muscle mass during training 53 Gains are
intake when an athlete doesnt have time to sit typically 2 5 pounds greater than controls
down for a good meal. However, they should during 4 12 weeks of training 54. The gains
be used to improve dietary availability of in muscle mass appear to be a result of an
macronutrients not as a replacement for a improved ability to perform high intensity
good diet. Care should also be taken to make exercise enabling an athlete to train harder
sure they do not contain any banned or and thereby promote greater training
prohibited nutrients. adaptations and muscle hypertrophy 55-57. The
only clinically significant side effect reported
Muscle Building Supplements from creatine supplementation has been
weight gain 36, 53, 54, 58 Although concerns
The following provides an analysis of the have been raised about the safety and possible
literature regarding purported weight gain side effects of creatine supplementation 59, 60,
supplements and our general interpretation of recent long-term safety studies have reported
how they should be categorized based on this no apparent side effects 58, 61, 62 and/or that
information. Table 3 summarizes how we creatine may lessen the incidence of injury
currently classify the ergogenic value of a during training 63-65. Consequently,
number of purported performance-enhancing, supplementing the diet with creatine and/or
muscle building, and fat loss supplements creatine containing formulations seems to be
based on an analysis of the available scientific a safe and effective method to increase
evidence. muscle mass.
the treatment of osteoporosis) 112-114. For this and development. The result is that these
reason, soy protein (which is an excellent animals experience what has been termed as a
source of isoflavones) and isoflavone extracts double-muscle phenomenon apparently by
have been investigated in the possible allowing muscle to grow beyond its normal
treatment of osteoporosis. Results of these genetic limit. In agriculture research,
studies have shown promise in preventing eliminating and/or inhibiting myostatin may
declines in bone mass in post-menopausal serve as an effective way to optimize animal
women as well as reducing risks to side growth leading to larger, leaner, and a more
effects associated with estrogen replacement profitable livestock yield. In humans,
therapy. More recently, the isoflavone inhibiting myostatin gene expression has been
extracts 7-isopropoxyisoflavone (ipriflavone) theorized as a way to prevent or slow down
and 5-methyl-7-methoxy-isoflavone muscle wasting in various diseases, speed up
(methoxyisoflavone) have been marketed as recovery of injured muscles, and/or promote
powerful anabolic substances. These claims increases in muscle mass and strength in
have been based on research described in athletes 123. While these theoretical
patents filed in Hungary in the early 1970s 115, possibilities may have great promise, research
116
. Although the data presented in the patents on the role of myostatin inhibition on muscle
are interesting, there is currently no peer- growth and repair is in the very early stages
reviewed data indicating that isoflavone particularly in humans. There is some
supplementation affects exercise, body evidence that myostatin levels are higher in
composition, or training adaptations. the blood of HIV positive patients who have
experience muscle wasting and that myostatin
Ornithine--ketoglutarate (OKG). OKG is levels negatively correlate with muscle
another nutrient believed to possess mass118. There is also evidence that
anabolic/catabolic effect. Animal and clinical myostatin gene expression may be fiber
studies have suggested that patients specific and that myostatin levels may be
administered OKG experienced improved influenced by immobilization in animals 124.
protein balance 115, 116. Theoretically, OKG Additionally, a recent study by Ivey and
may provide some value for athletes engaged colleagues 123 reported that female athletes
in intense training. A recent study by Chetlin with a less common myostatin allele (a
and colleagues 117 reported that OKG genetic subtype that may be more resistant to
supplementation (10 grams/day) during 6- myostatin) experienced greater gains in
weeks of resistance training promoted greater muscle mass during training and less loss of
gains in bench press. However, no significant muscle mass during detraining. No such
differences were observed in squat strength, pattern was observed in men with varying
training volume, gains in muscle mass, or amounts of training histories and muscle
fasting insulin and growth hormone. mass. These early studies suggest that
Therefore, additional research is needed myostatin may play a role in regulating
before conclusions can be drawn. muscle growth to some degree. Recently,
some nutrition supplement companies have
Sulfo-Polysaccharides (Myostatin marketed sulfo-polysaccharides (derived from
Inhibitors). Myostatin or growth a sea algae called Cytoseira canariensis) as a
differentiation factor 8 (GDF-8) is a way to partially bind the myostatin protein in
transforming growth factor that has been serum. Although this theory is interesting and
shown to serve as a genetic determinant of the studies examining this hypothesis are
upper limit of muscle size and growth 118. underway, there is currently no published data
Recent research has indicated that eliminating supporting the use of sulfo-polysaccharides as
and/or inhibiting myostatin gene expression a muscle building supplement.
in mice 119 and cattle 120-122 promotes marked
increases in muscle mass during early growth
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 17
research supports their use. See Table 3 for a Increasing protein intake during weight loss
summary. helps preserve muscle mass and resting
energy expenditure to a better degree than
high carbohydrate diets 199. These findings
Apparently Effective
and others indicate that VLCDs (typically
using MRPs and/or RTDs as a means to
Low Calorie Diet Foods & Supplements.
Most of the products in this category control caloric intake) can be effective
represent low fat/carbohydrate, high protein particularly as part of an exercise and
food alternatives 191. They typically consist behavioral modification program. Most
of pre-packaged food, bars, MRP, or RTD people appear to maintain at least half of the
supplements. They are designed to provide initial weight lost for 1-2 years but tend to
convenient foods/snacks to help people follow regain most of the weight back within 2-5
a particular low calorie diet plan. In the years. Therefore, although these diets may
scientific literature, diets that provide less help people lose weight on the short-term, it
than 1000 calories per day are known as very is essential people who use them follow good
low calorie diets (VLCDs). Pre-packaged diet and exercise practices in order to
maintain the weight loss.
food, MRPs, and/or RTDs are often
provided in VLCD plans to help people cut
calories. In most cases, VLCD plans Ephedra, Caffeine, and Silicin.
recommend behavioral modification and that Thermogenics are supplements designed to
people start a general exercise program. stimulate metabolism thereby increasing
energy expenditure and promote weight loss.
Research on the safety and efficacy of people They typically contain the ECA stack of
maintaining VLCDs generally indicate that ephedra alkaloids (e.g., Ma Haung, 1R,2S
they can promote weight loss. For example, Nor-ephedrine HCl, Sida Cordifolia), caffeine
Hoie et al 192 reported that maintaining a (e.g., Gaurana, Bissey Nut, Kola) and
aspirin/salicin (e.g., Willow Bark Extract).
VLCD for 8-weeks promoted a 27 lbs
More recently, other potentially thermogenic
(12.6%) loss in total body mass, a 21 lbs loss
nutrients have been added to various
in body fat (23.8%), and a 7 lbs (5.2%) loss in
thermogenic formulations. For example,
lean body mass in 127 overweight volunteers.
thermogenic supplements may also contain
Bryner and colleagues 193 reported that
synephrine (e.g., Citrus Aurantum, Bitter
addition of a resistance training program
Orange), calcium & sodium phosphate,
while maintaining a VLCD (800 kcal/d for
thyroid stimulators (e.g., guggulsterones, L-
12-weeks) resulted in a better preservation of
tyrosine, iodine), cayenne & black pepper,
lean body mass and resting metabolic rate
and ginger root.
compared to subjects maintaining a VLCD
while engaged in an endurance training
A significant amount of research has
program. Kern and coworkers 194 reported
evaluated the safety and efficacy of EC and
that a medically supervised weight loss
ECA type supplements. Studies show that
program involving behavioral modification
use of synthetic or herbal sources of
and VLCD promoted a 51 lbs weight loss and
ephedrine and caffeine (EC) promote about 2
that 61% of subjects maintained at least 50%
lbs of extra weight loss per month while
of the weight loss at 12 and 18 months
dieting (with or without exercise) and that EC
follow-up. Recent studies indicate that high
supplementation is generally well tolerated in
protein/low fat VLCDs may be better than
healthy individuals 200-209. For example,
high carbohydrate/low fat diets in promoting
weight loss 32, 195-198. The reason for this is Boozer et al 201 reported that 8-weeks of
that typically when people lose weight about ephedrine (72 mg/d) and caffeine (240 mg/d)
40-50% of the weight loss is muscle which supplementation promoted a 9 lbs loss in
body mass and a 2.1 % loss in body fat with
decreases resting energy expenditure.
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 20
minor side effects. Molnar and associates 200 foods (fruits, vegetables) or fiber supplements
reported that overweight children treated for increase the feeling of fullness (satiety). They
20 weeks with ephedrine and caffeine typically allow you to feel full while ingesting
observed a 14.4% loss in body mass and a fewer calories. Theoretically, maintaining a
6.6% decrease in body fat with no differences high fiber diet may serve to help decrease the
in side effects. Interestingly, Greenway and amount of food you eat. In addition, high
colleagues 208reported that EC fiber diets/supplements have also been
supplementation was a more cost-effective purported to help lower cholesterol and blood
treatment for reducing weight, cardiac risk, pressure as well as help diabetics manage
and LDL cholesterol than several weight loss glucose and insulin levels. Some of the
drugs (fenfluramine with mazindol or research conducted on high fiber diets
phentermine). Finally, Boozer and associates indicates that they provide some benefit,
200
reported that 6-months of herbal EC particularly in diabetic populations. For
supplementation promoted weight loss with example, Raben et al 212 reported that subjects
no clinically significant adverse effects in maintaining a low fat/high fiber diet for 11
healthy overweight adults. Less is known weeks lost about 3 lbs of weight and 3.5 lbs
about the safety and efficacy of synephrine, of fat. Other studies report either no
thyroid stimulators, cayenne/black pepper and significant effects or modest amounts of fat
ginger root. loss. High fiber/low fat diets have also been
found to help reduce cholesterol.
Despite these findings, the Food and Drug Consequently, although maintaining a low fat
Administration (FDA) has recently banned / high fiber diet may have some health
the sale of ephedra containing supplements. benefits, they do not appear to promote a
The rationale has been based on reports to significant amount of weight or fat loss.
adverse event monitoring systems and in the
media suggesting a link between intake of Calcium. Research has indicated that calcium
ephedra and a number of severe medical modulates 1,25-diydroxyvitamin D which
complications (e.g., high blood pressure, serves to regulate intracellular calcium levels
elevated heart rate, arrhythmias, sudden in fat cells 213-215. Increasing dietary
death, heat stroke, etc) 210, 211. Although availability of calcium reduces 1,25-
results of available clinical studies do not diydroxyvitamin D and promotes reductions
show these types of adverse events and the in fat mass in animals 213-215. Dietary calcium
ban is in the process of being contested has been shown to suppress fat metabolism
legally, ephedra is no longer available as an and weight gain during periods of high caloric
ingredient in dietary supplements. intake 213, 216. Further, increasing calcium
Consequently, thermogenic supplements now intake has been shown to increase fat
contain other nutrients believed to increase metabolism and preserve thermogenesis
energy expenditure (e.g., synephrine, green during caloric restriction 213, 216, 217. In
tea, etc). Anyone contemplating taking support of this theory, Davies and colleagues
218
thermogenic supplements should carefully reported that dietary calcium was
consider the potential side effects, discuss negatively correlated to weight and that
possible use with a knowledgeable physician, calcium supplementation (1,000 mg/d)
and be careful not exceed recommended accounted for an 8 kg weight loss over a 4 yr
dosages. period. Additionally, Zemel and associates
213
reported that supplemental calcium (800
Possibly Effective mg/d) or high dietary intake of calcium (1,200
1,300 mg/d) during a 24-week weight loss
High Fiber Diets. One oldest and most program promoted significantly greater
common methods of suppressing the appetite weight loss (26-70%) and dual energy x-ray
is to eat a high fiber diet. Ingesting high fiber absorptiometer (DEXA) determined fat mass
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 21
loss (38-64%) compared to subjects on a low day) significantly increased 24-hour energy
calcium diet (400-500 mg/d). These findings expenditure and fat utilization in humans.
and others suggest a strong relationship The thermogenic effects of green tea
between calcium intake and fat loss. supplementation were much greater than
when an equivalent amount of caffeine was
Phosphates. The role of sodium and calcium evaluated suggesting a synergistic effect.
phosphate on energy metabolism and exercise Theoretically, increases in energy expenditure
performance has been studied for decades 36. may help individuals lose weight and/or
These studies have revealed that sodium manage body composition.
phosphate supplementation appears to possess
ergogenic properties particularly in endurance Calcium Pyruvate. Calcium Pyruvate is
exercise events 219, 220. More recently, supplement that hit the scene about five or six
phosphate supplementation has also been years ago with great promise. The theoretical
suggested to affect energy expenditure. For rationale was based on studies from the early
example, Kaciuba-Uscilko and colleagues 221 1990s that reported that calcium pyruvate
reported that phosphate supplementation supplementation (16 25 g/d with or without
during a 4-week weight loss program dihydroxyacetone phosphate [DHAP])
increased resting metabolic rate (RMR) and promoted fat loss in overweight/obese
respiratory exchange ratio (suggesting greater patients following a medially supervised
carbohydrate utilization and caloric weight loss program 226-228. Although the
expenditure) during submaximal cycling mechanism for these findings was unclear, the
exercise. In addition, Nazar and coworkers researchers speculated that it might be related
222
reported that phosphate supplementation to appetite suppression and/or altered
during an 8-week weight loss program carbohydrate and fat metabolism. Since
increased RMR by 12-19% and prevented a calcium pyruvate is very expensive, several
normal decline in thyroid hormones. studies have attempted to determine whether
Although the rate of weight loss was similar ingesting smaller amounts of calcium
in this trial, results suggest that phosphate pyruvate (6-10 g/d) affect body composition
supplementation may influence metabolic rate in untrained and trained populations. Results
possibly by affecting thyroid hormones. of these studies are mixed. Kalman and
Consequently, it is possible that phosphate colleagues 229 reported that calcium pyruvate
could serve as a potential thermogenic supplementation (6 g/d for 6-weeks)
nutrient in non-ephedrine based supplements. significantly decreased body weight (-1.2 kg),
Additional research is necessary to test this body fat (-2.5 kg), and percent body fat (-
hypothesis. 2.7%). However, Stone and colleagues 230
reported that pyruvate supplementation did
Green Tea Extract. Green tea is one of the not affect hydrostatically determined body
more interesting herbal supplements that has composition during 5-weeks of in-season
recently been suggested to affect weight loss. college football training. These findings
Green tea contains high amounts of caffeine indicate that although there is some
and catechin polyphenols. Research suggests supportive data indicating that calcium
that catechin polyphenols possess antioxidant pyruvate supplementation may enhance fat
properties 223. In addition, green tea has also loss when taken at high doses (6-16 g/d),
been theorized to increase energy expenditure there is no evidence that ingesting the doses
by stimulating brown adipose tissue typically found in pyruvate supplements (0.5
thermogenesis. In support of this theory, 2 g/d) has any affect on body composition.
Dulloo et al 224, 225 reported that green tea
supplementation in combination with caffeine Too Early to Tell
(e.g., 50 mg caffeine and 90 mg
epigallocatechin gallate taken 3-times per Gymnema Sylvestre. Gymnema Sylvestre is a
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 22
liver metabolism, fat metabolism, and fat coleus forskohlii in overweight women helped
deposition in animals 249, 250. There has also maintain weight and was not associated with
been interest in determining whether betaine any clinically significant adverse events 259.
supplementation may help lower Additional research is needed before
homocysteine levels which has recently been conclusions can be drawn.
identified as a marker of risk to heart disease
251
. For this reason, betaine supplements have Dehydroepiandrosterone (DHEA) and 7-
been marketed as a supplement designed to Keto DHEA. Dehydroepiandrosterone
promote heart health as well as a weight loss. (DHEA) and its sulfated conjugate DHEAS
Although the potential theoretical rationale of represent the most abundant adrenal steroids
betaine supplementation is interesting, it is in circulation 260. Although, DHEA is
currently unclear whether betaine considered a weak androgen, it can be
supplementation may serve as an effective converted to the more potent androgens
weight loss supplement in humans. testosterone and dihydrotestosterone in
tissues. In addition, DHEAS can be
Coleus Forskohlii (Forskolin). Forskolin is converted into androstenedione and
another relatively new weight loss testosterone. DHEA levels have been
supplement. Forskolin is a plant native to reported to decline with age in humans 261.
India that has been used for centuries in The decline in DHEA levels with aging has
traditional Ayurvedic medicine primarily to been associated with increased fat
treat skin disorders and respiratory problems accumulation and risk to heart disease 262.
252, 253
. A considerable amount of research Since DHEA is a naturally occurring
has evaluated the physiological and potential compound, it has been suggested that dietary
medical applications of forskolin over the last supplementation of DHEA may help maintain
25 years. Forskolin has been reported to DHEA availability, maintain and/or increase
reduce blood pressure, increase the hearts testosterone levels, reduce body fat
ability to contract, help inhibit platelet accumulation, and/or reduce risk to heart
aggregation, improve lung function, and aid disease as one ages 260, 262. Although animal
in the treatment of glaucoma 252-254. With studies have generally supported this theory,
regard to weight loss, forskolin has been the effects of DHEA supplementation on
reported to increase cyclic AMP and thereby body composition in human trials have been
stimulate fat metabolism 255-257. mixed. For example, Nestler and coworkers
263
Theoretically, forskolin may therefore serve reported that DHEA supplementation
as an effective weight loss supplement. In (1,600 mg/d for 28-d) in untrained healthy
support of this theory, Sabinsa Corporation males promoted a 31% reduction in
(the principle source for Forskolin in the percentage of body fat. However, Vogiatzi
U.S.) reported that forskolin supplementation and associates 264 reported that DHEA
(250 mg of a 10% forskolin extract taken supplementation (40 mg/d for 8 wks) had no
twice daily for 8-weeks) administered in an effect on body weight, percent body fat, or
open label manner to six overweight females serum lipid levels in obese adolescents. More
promoted a 7.25 lbs loss in body weight and a recently, 7-keto DHEA has been marketed as
7.7% decrease bioelectrical impedance (BIA) a potentially more effective form of DHEA.
determined body fat 258. Although this was 7-keto DHEA is a precursor to DHEA that is
not a placebo controlled double blind study believed to possess lypolytic properties.
and BIA is not the most accurate method of Although data are limited, Kalman and
assessing body composition, these colleagues and coworkers 265 reported that 7-
preliminary findings provide some support to keto DHEA supplementation (200 mg/d)
contentions that forskolin supplementation during 8-weeks of training promoted a greater
may promote fat loss. Another recent study loss in body mass and fat mass while
suggested that supplementing the diet with increasing T3. No significant effects were
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 24
more than 2% of body weight during exercise optimize creatine and carbohydrate loading
289
(e.g., 180 lbs x 0.02 = 3.6 lbs). Sports drinks . Most endurance athletes also perform
contain salt and carbohydrate. Studies show interval training (sprint or speed work) in an
that ingestion of sports drinks during exercise attempt to improve anaerobic threshold.
in hot/humid environments can help prevent Since creatine has been reported to enhance
dehydration and improve endurance exercise interval sprint performance, creatine
capacity 43. Consequently, frequent ingestion supplementation during training may improve
of water and/or sports drinks during exercise training adaptations in endurance athletes 290,
291
is one of the easiest and most effective . Finally, many endurance athletes lose
ergogenic aids. weight during their competitive season.
Creatine supplementation during training may
Carbohydrate. General nutritional needs help people maintain weight.
were discussed earlier. However, one of the
best ergogenic aids available for active people Sodium Phosphate. We previously
is carbohydrate. Athletes and active mentioned that sodium phosphate
individuals should consume a diet high in supplementation may increase resting energy
carbohydrate (e.g., 55 65% of calories or 5- expenditure and therefore could serve as a
8 grams/kg/day) in order to maintain muscle potential weight loss nutrient. However, most
and liver carbohydrate stores 1. Additionally, research on sodium phosphate has actually
ingesting a small amount of carbohydrate and evaluated the potential ergogenic value. A
protein 30-60 minutes prior to exercise and number of studies indicated that sodium
use of sports drinks during exercise can phosphate supplementation (e.g., 1 gram
increase carbohydrate availability and taken 4 times daily for 3-6 days) can increase
improve exercise performance. Finally, maximal oxygen uptake (i.e., maximal
ingesting carbohydrate and protein aerobic capacity) and anaerobic threshold by
immediately following exercise can enhance 5-10% 219, 220, 292, 293. These finding suggest
carbohydrate storage and protein synthesis 1. that sodium phosphate may be highly
effective in improving endurance exercise
Creatine. Earlier we indicated that creatine capacity. Other forms of phosphate (i.e.,
supplementation is one of the best calcium phosphate, potassium phosphate) do
supplements available to increase muscle not appear to possess ergogenic value.
mass and strength during training. However,
creatine has also been reported to improve Sodium Bicarbonate (Baking Soda). During
exercise capacity in a variety of events 54. high intensity exercise, acid (H+) and carbon
This is particularly true when performing high dioxide (CO2) accumulate in the muscle and
intensity, intermittent exercise such as blood. One of the ways you get rid of the
multiple sets of weight lifting, repeated acidity and CO2 is to buffer the acid and CO2
sprints, and/or exercise involving sprinting with bicarbonate ions. The acid and CO2 are
and jogging (e.g., soccer) 54. Although then removed in the lungs. Bicarbonate
studies evaluating the ergogenic value of loading (e.g., 0.3 grams per kg taken 60-90
creatine on endurance exercise performance minutes prior to exercise or 5 grams taken 2
are mixed, endurance athletes may also times per day for 5-days) has been shown to
theoretically benefit in several ways. For be an effective way to buffer acidity during
example, increasing creatine stores prior to high intensity exercise lasting 1-3 minutes in
carbohydrate loading (i.e., increasing dietary duration 294-297. This can improve exercise
carbohydrate intake before competition in an capacity in events like the 400 - 800 m run or
attempt to maximize carbohydrate stores) has 100 200 m swim 298. Although bicarbonate
been shown to improve the ability to store loading can improve exercise, some people
carbohydrate 286-288. Further, coingesting have difficulty with their stomach tolerating
creatine with carbohydrate has been shown to
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 27
Glycerol. Ingesting glycerol with water has Ribose. Ribose is a 3-carbon carbohydrate
been reported to increase fluid retention 305. that is involved in the synthesis of adenosine
Theoretically, this should help athletes triphosphate (ATP) in the muscle (the useable
prevent dehydration during prolonged form of energy). Clinical studies have shown
exercise and improve performance that ribose supplementation can increase
particularly if they are susceptible to exercise capacity in heart patients 323-327. For
dehydration. Although studies indicate that this reason, ribose has been suggested to be an
glycerol can significantly enhance body fluid, ergogenic aid for athletes. Although more
studies are mixed on whether it can improve research is needed, most studies show no
exercise capacity 52, 306-311. ergogenic value of ribose supplementation on
exercise capacity in health untrained or
Ephedrine/Caffeine. Most research has trained populations 328-330.
evaluated the effects of ingesting ephedrine
and caffeine (EC) supplements on weight Apparently Ineffective
loss. However, since ephedra and caffeine are
stimulants and caffeine has been shown to Inosine. Inosine is a building block for DNA
have ergogenic properties, there has also been and RNA that is found in muscle. Inosine has
interest in the potential ergogenic value of a number of potentially important roles that
EC. Recent research has shown that ingestion may enhance training and/or exercise
of low to moderate amounts of synthetic EC performance 331. Although there is some
supplements generally improves endurance theoretical rationale, available studies indicate
and high intensity exercise performance with that inosine supplementation has no apparent
no apparent adverse effects 312-316. However, affect on exercise performance capacity 332-
334
it is unclear whether dietary supplements .
containing botanical ephedrine (i.e., ephedra)
and caffeine (e.g., kola nut) have similar Supplements to Promote General Health
effects on performance. Further, since most
sport organizations ban use of ephedrine the In addition to the supplements previously
potential use in athletes appears limited. described, several nutrients have been
suggested to help athletes stay healthy during
Too Early to Tell intense training. For example, the American
Medical Association recently recommended
A number of supplements purported to that all Americans ingest a daily low-dose
enhance performance and/or training multivitamin in order to ensure that people get
adaptation fall under this category. This a sufficient amount of vitamins and minerals
includes the weight gain and weight loss in their diet. Although one-a-day vitamin
supplements listed in Table 3 as well as the supplementation has not been found to
following supplements not previously improve exercise capacity in athletes, it may
described in this category. make sense to take a daily vitamin
supplement for health reasons. Glucosomine
Medium Chain Triglycerides (MCT). and chondroitin have been reported to slow
MCTs are shorter chain fatty acids that can cartilage degeneration and reduce the degree
easily enter the mitochondria of the cell and of joint pain in active individuals which may
be converted to energy through fat help athletes postpone and/or prevent joint
metabolism 317. Studies are mixed as to problems 335, 336. Vitamin C, glutamine,
whether MCTs can serve as an effective Echinacea, and zinc have been reported to
source of fat during exercise metabolism enhance immune function 42, 337-339.
and/or improve exercise performance 318-322. Consequently, some sport nutritionists
recommend that athletes who feel a cold
coming on take these nutrients in order to
Sports Nutrition Review Journal. 1 (1):1-44, 2004. (www.sportsnutritionsociety.org) 29
enhance immune function 42, 337-339. training, maintaining an energy balance and
Similarly, nutrients such as vitamins E and C nutrient dense diet, proper timing of nutrient
may help restore overwhelmed anti-oxidant intake, and obtaining adequate rest are the
defenses exhibited by athletes and reduce the cornerstones to enhancing performance and/or
risk of numerous chronic diseases 340. training adaptations. Use of a limited number
Creatine, calcium -HMB, BCAA, and L- of nutritional supplements that research has
carnitine have been shown to help athletes supported can help improve energy
tolerate heavy training periods 36, 74, 80, 81, 83, availability (e.g., sports drinks, carbohydrate,
341-344
. Finally, omega-3 fatty acids, in creatine, caffeine, etc) and/or promote
supplemental form, are now endorsed by the recovery (carbohydrate, protein, essential
American Heart Association for heart health amino acids, etc) can provide additional
in certain individuals 345. This supportive benefit in certain instances. The sport
supplement position stems from: 1.) an nutrition specialist should stay up to date
inability to consume cardio-protective regarding the role of nutrition on exercise so
amounts by diet alone; and, 2.) the mercury they can provide honest and accurate
contamination sometimes present in whole- information to their students, clients, and/or
food sources of DHA (docosahexaenoic acid) athletes about the role of nutrition and dietary
and EPA (eicosapentaenoic acid) found in supplements on performance and training.
fatty fish. Consequently, prudent use of Furthermore, the sport nutrition specialist
these types of nutrients at various times should actively participate in exercise
during training may help athletes stay healthy nutrition research; write unbiased scholarly
and/or tolerate training to a greater degree 37. reviews for journals and lay publications; help
disseminate the latest research findings to the
SUMMARY public so they can make informed decisions
about appropriate methods of exercise,
Numerous nutritional and herbal products are dieting, and/or whether various nutritional
marketed to promote weight gain, weight loss, supplements can affect health, performance,
and/or improve performance. Most have a and/or training; and, disclose any commercial
theoretical basis for use but little data or financial conflicts of interest during such
supporting safety and efficacy in athletes. A promulgations to the public. Finally, sport
number are heavily marketed despite data nutrition specialists can challenge companies
indicating that they do not affect body who sell exercise equipment and/or nutritional
composition, performance, and/or training supplements to develop scientifically based
adaptations at the dosages recommended. It products, conduct research on their products,
is in these particular situations that and honestly market the results of studies so
unsupported claims explicitly or implicitly consumers can make informed decisions.
endorsed by sport nutrition specialists
constitute fraud and/ or quackery. Prudent
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Cyano- 2.4 mcg/d A coenzyme involved in the production of DNA and serotonin. In well-nourished athletes, no ergogenic effect has been reported.
cobalamin DNA is important in protein and red blood cell synthesis. However, when combined with vitamins B1 and B6, cyanocobalamin
(B12) Theoretically, it would increase muscle mass, the oxygen- has been shown to improve performance in pistol shooting 358. This
carrying capacity of blood, and decrease anxiety. may be due to increased levels of serotonin, a neurotransmitter in the
brain, which may reduce anxiety.
Folic acid 400 mcg/d Functions as a coenzyme in the formation of DNA and red Studies suggest that increasing dietary availability of folic acid
(folate) blood cells. An increase in red blood cells could improve during pregnancy can lower the incidence of birth defects 359.
oxygen delivery to the muscles during exercise. Believed to be Additionally, it may decrease homocysteine levels (a risk factor for
important to help prevent birth defects and may help decrease heart disease) 360. In well-nourished and folate deficient-athletes,
homocysteine levels. folic acid did not improve exercise performance 361.
Pantothenic 5 mg/d Acts as a coenzyme for acetyl coenzyme A (acetyl CoA). This Research has reported no improvements in aerobic performance with
acid may benefit aerobic or oxygen energy systems. acetyl CoA supplementation. However, one study reported a
decrease in lactic acid accumulation, without an improvement in
performance 362.
Beta carotene None Serves as an antioxidant. Theorized to help minimize exercise- Research indicates that beta carotene supplementation with or
induced lipid peroxidation and muscle damage. without other antioxidants can help decrease exercise-induced
peroxidation. Over time, this may help athletes tolerate training.
However, it is unclear whether antioxidant supplementation affects
exercise performance 349.
Vitamin C Males 90 mg/d Used in a number of different metabolic processes in the body. In well-nourished athletes, vitamin C supplementation does not
Females 75 mg/d It is involved in the synthesis of epinephrine, iron absorption, appear to improve physical performance 363, 364. However, there is
and is an antioxidant. Theoretically, it could benefit exercise some evidence that vitamin C supplementation (e.g., 500 mg/d)
performance by improving metabolism during exercise. There following intense exercise may decrease the incidence of upper
is also evidence that vitamin C may enhance immunity. respiratory tract infections 337, 365, 366.
Recommended Dietary Allowances (RDA) based on the 1989 Food & Nutrition Board, National Academy of Sciences-National Research Council recommendations. Updated
in 2001.
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Table 2. Proposed Nutritional Ergogenic Aids Minerals
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Selenium 55 Marketed as a supplement to increase aerobic exercise Although selenium may reduce lipid peroxidation during aerobic
mcg/d performance. Working closely with vitamin E and glutathione exercise, improvements in aerobic capacity have not been
peroxidase (an antioxidant), selenium may destroy destructive demonstrated 375, 376.
free radical production of lipids during aerobic exercise.
Sodium 500 mg/d* During the first several days of intense training in the heat, a greater
amount of sodium is lost in sweat. Additionally, prolonged
ultraendurance exercise may decrease sodium levels leading to
hyponatremia. Increasing salt availability during heavy training in
the heat has been shown to help maintain fluid balance and prevent
hyponatremia 374, 377.
Vanadyl None Vanadium may be involved in reactions in the body that Limited research has shown that type 2 diabetics may improve their
sulfate produce insulin-like effects on protein and glucose metabolism. glucose control; however, there is no proof that vanadyl sulfate has
(vanadium) Due to the anabolic nature of insulin, this has brought attention any effect on muscle mass, strength, or power 189, 190.
to vanadium as a supplement to increase muscle mass, enhance
strength and power.
Zinc Males 11 mg/d Constituent of enzymes involved in digestion. Associated with Studies indicate that zinc supplementation (25 mg/d) during training
Females 8 mg/d immunity. Theorized to reduce incidence of upper respiratory minimized exercise-induced changes in immune function 42, 339, 378,
379
tract infections in athletes involved in heavy training. .
Recommended Dietary Allowances (RDA) based on the 2002 Food & Nutrition Board, National Academy of Sciences-National Research Council recommendations.
* Estimated minimum requirement
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Table 3. Categorization of the Ergogenic Value of Performance Enhancement, Muscle Building, and Weight Loss Supplements
Category Muscle Building Supplements Weight Loss Supplements Performance
Enhancement
I.. Apparently effective and Weight gain powders Low-calorie foods, MRPs and RTDs that Water and sports drinks
generally safe Creatine help individuals maintain a hypocaloric Carbohydrate
HMB (untrained individuals diet Creatine
initiating training) Ephedra, caffeine, and salicin-containing Sodium phosphate
thermogenic supplements taken at Sodium bicarbonate
recommended doses in appropriate Caffeine
populations (now banned by FDA)
II. Possibly effective Postexercise carbohydrate and High-fiber diets Postexercise CHO/PRO
protein Calcium Glutamine
BCAA Phosphate EAA
Essential amino acids (EAA) Green tea extract BCAA
Glutamine Pyruvate/DHAP (at high doses) HMB (trained subjects)
Protein Glycerol
HMB (trained subjects) Low doses of ephedrine/caffeine (now
banned by FDA)
III. Too early to tell -Ketoglutarate Appetite suppressants and fat blockers Medium chain triglycerides
-Ketoisocaproate (KIC) (Gymnema sylvestre, chitosan) Ribose
Ecdysterones Thermogenics (synephrine, thyroid
Growth hormone releasing stimulators, cayenne pepper, black
peptides (GHRP) and secretogues pepper, ginger root)
HMB (trained athletes) Lipolytic nutrients (phosphatidyl
Isoflavones choline, betaine, Coleus forskohlii, 7-
Sulfo-polysaccharides keto DHEA)
(myostatin inhibitors) Psychotropic Nutrients/Herbs
Zinc/magnesium aspartate (ZMA)
44